Association between advanced lung cancer inflammation index and postoperative mortality in lung cancer patients: a...

Lung cancer is the leading cause of cancer-related death. Surgical resection of early-stage non-small cell lung cancer (NSCLC) is associated with a suboptimal survival rate and significant adverse outcomes. The advanced lung cancer inflammation index (ALI), which integrates body mass index (BMI), albumin level, and neutrophil-to-lymphocyte ratio (NLR), comprehensively assesses nutritional and inflammatory status, potentially improving prognostic precision in surgical patients.

This retrospective cohort study analyzed 2447 patients who underwent lung cancer resection (INSPIRE database, South Korea, 2011-2020). The ALI (BMI × Albumin/NLR) was calculated preoperatively. Patients were stratified into high (≥ 37.22) and low (< 37.22) ALI groups (receiver operating characteristic curve-determined cut-off). Associations between ALI and mortality (primary: 90-day; secondary: 180-day, in-hospital) were assessed using multivariate regression after adjusting for demographics, surgical factors, and key laboratory parameters.

The low ALI group (n = 805) was older (64.2 vs 63.2 years, p = 0.018), had more males (63.2% vs. 51.2%, p < 0.001), and exhibited significantly poorer laboratory profiles (e.g., lower hematocrit and hemoglobin levels; higher white blood cell count and C-reactive protein levels; all p < 0.001) than the high ALI group (n = 1642). Mortality rates were significantly higher in the low ALI group (90-day: 1.6% vs 0.1%; 180-day: 3.2% vs 0.5%; in-hospital: 2.0% vs 0.4%; all p < 0.001). After full adjustment, compared with the low ALI group, the high ALI group had an 82% lower risk of 90-day mortality (HR 0.18, 95% CI 0.04-0.81) and a 70% lower risk of 180-day mortality (HR 0.30, 95% CI 0.13-0.70). Each 1-unit increase in ALI was linked to a 4% reduction in 90-day mortality risk (HR 0.96, 95% CI 0.93-0.99). High ALI was also associated with an 66% lower odds of in-hospital mortality (OR 0.34, 95% CI 0.12-0.96).

Our study shows that ALI is significantly associated with poor clinical prognosis after lung cancer resection. The lower the ALI, the higher the 90-day, 180-day, and in-hospital mortality rates.